{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBIN   N FITCH","gend":1,"add":"920 SHENANDOAH AVE APT 4","city":"WAYNESBORO","state":"VA","zip":"22980-9998","dob":"1984-10-01","age":"","mstatus":"","insh":"1074439*01","cliId":"","pno":"540\/487-6513","cno":"","email":"","ename":"","eno":"","pphy":"DAVIES, CATHERINE W DO","ppno":"540\/213-2630","pcpadd":"53 S MEDICAL PARK DRIVE","pcpcity":"FISHERSVILLE","pcpstate":"VA","pcpzip":22939,"pcpcounty":"","pcpid":"","pcpname":"AUGUSTA MEDICAL GROUP","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/213-2631","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","F17.200","E66.01","E55.9","I10.","M54.17","S06.0X0A","M25.561","R68.84","K04.7","F32.9","Z86.718","Z88.5","Z88.8","L73.2","Z20.828","R13.13","R07.0","R51.9","R06.83","S69.92XA","Y04.8XXA","R51.","M79.641","M79.642","I82.409","Z13.1","Z68.43","NO DATA","B37.3","F10.10","R31.9","F17.210","R00.0","Z83.3","R35.0","R06.81","G47.9","G47.10","R09.89","R10.30","R10.32","R11.0","M79.89","M79.605","R42.","R53.1","G43.109","E11.9","Z79.4","Z72.0","M54.5","Z98.890","E10.65","R10.13","Z79.84","Z79.899","Z88.1","M25.562","R10.11","R19.4","K59.00","F45.8","Z86.010","G47.00","Z09.","K64.1","K62.1","M79.662","E87.2","M54.16","E53.8","K12.0","L05.91","Z12.11","K63.5","Z98.891","M51.36","M47.896","M17.11","Z68.42","H53.8","R03.0","R06.00","R07.89","E66.9","Z79.01","Z90.710","Z82.49","I16.1","L08.9","L80.","I16.0","Z20.2","N76.0","M79.604","Z88.6","L42.","S86.912A","R20.0","S00.211A","R10.33","K29.70","E87.6","E11.8","L28.2","R22.42","R50.9","Z20.822","R30.9","R21.","R30.0","Z11.3","K59.04"],"date":["2022-10-18","2022-10-18","2022-10-18","2022-10-18","2022-10-18","2021-02-11","2021-05-14","2021-06-21","2021-06-24","2021-09-17","2021-06-24","2022-06-30","2022-06-30","2022-06-30","2021-08-23","2020-12-03","2021-01-12","2022-11-10","2021-03-26","2021-07-26","2020-04-12","2020-04-12","2020-06-30","2021-05-18","2021-05-18","2020-08-05","2020-08-05","2021-06-21","2022-01-08","2020-10-03","2020-10-02","2020-10-02","2020-10-05","2020-10-02","2020-10-02","2021-05-18","2021-07-21","2021-07-21","2021-07-21","2021-07-21","2021-08-26","2022-11-10","2022-04-06","2020-08-07","2022-06-30","2020-08-07","2020-08-07","2020-08-07","2021-11-13","2020-10-16","2020-10-16","2021-01-28","2021-01-28","2021-05-23","2021-05-23","2022-03-15","2022-06-30","2021-11-13","2020-03-04","2021-06-21","2021-06-21","2020-01-30","2020-01-30","2020-02-21","2020-01-30","2020-02-21","2020-02-21","2020-02-21","2020-03-04","2020-10-02","2020-12-21","2021-01-20","2021-08-11","2021-11-19","2020-02-21","2020-02-21","2020-10-19","2021-02-22","2021-02-22","2021-05-25","2021-05-25","2021-12-23","2021-12-23","2019-03-18","2019-03-18","2019-09-10","2019-09-07","2019-09-07","2019-09-07","2019-09-07","2019-07-01","2019-07-01","2019-09-09","2022-01-19","2022-01-19","2022-06-30","2022-06-30","2022-10-17","2022-03-15","2022-03-15","2022-03-20","2022-04-06","2022-04-06","2022-04-06","2022-10-18","2022-10-18","2022-03-15","2022-01-08","2022-01-08","2022-04-14","2022-06-30","2022-09-02","2022-09-02","2022-11-10"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","65862020299","LOSARTAN","TAB 50MG","60","Select","Select",""],["","","ONETOUCH","KIT ULTRA 2","","Select","Select",""],["","69315012710","FOLIC","TAB 1000MCG","90","Select","Select",""],["","59267102504","PFIZER","INJ ADLT RTU","0","Select","Select",""],["","00168027740","CLINDAMYCIN","CRE 2% VAG","40","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","00002143480","TRULICITY","INJ 1.5\/0.5","6","Select","Select",""],["","00093505998","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","00193709021","CONTOUR","TES BLD GLUC","100","Select","Select",""],["","00597015330","JARDIANCE","TAB 25MG","30","Select","Select",""],["","42806054701","VITAMIN","CAP 1.25MG","4","Select","Select",""],["","16714008210","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","64980032005","TRIAMCINOLON","PST DEN 0.1%","5","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","53885004401","ONE","KIT VERIO FL","1","Select","Select",""],["","67877019810","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","54092054701","MOTEGRITY","TAB 2MG","30","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","6","Select","Select",""],["","57237004101","PENICILLN","TAB 500MG","28","Select","Select",""],["","46122002999","OMEPRAZOLE","TAB 20MG","14","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","00143988701","AMOXICILLIN","SUS 400\/5ML","200","Select","Select",""],["","63736000885","SUCRETS","LOZ 2MG","18","Select","Select",""],["","51663000500","OPTIMAL-D","CAP 50000UNT","4","Select","Select",""],["","","METOPROL","TAB 25MG","","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","21","Select","Select",""],["","","METFORMIN","TAB 500MG","","Select","Select",""],["","31604004071","D3","TAB 2000UNIT","30","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","1","Select","Select",""],["","68001016208","PROMETHAZINE","TAB 25MG","12","Select","Select",""],["","00603533815","PREDNISONE","PAK 10MG","21","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","20","Select","Select",""],["","68645057290","GLIMEPIRIDE","TAB 2MG","60","Select","Select",""],["","16729018317","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","1680","Select","Select",""],["","49035048462","ACETAMINOPHN","TAB 500MG","24","Select","Select",""],["","49035030882","PAIN","TAB 500MG","24","Select","Select",""],["","00536132710","ACETAMINOPHE","TAB 325MG","30","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","","GAVILYTE-G","SOL ","","Select","Select",""],["","","EQ","CAP SOFTENER","","Select","Select",""],["","","MELATONIN","TAB 10MG","","Select","Select",""],["","","STOOL","CAP 100MG","","Select","Select",""],["","","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","","CLONIDINE","TAB 0.2MG","","Select","Select",""],["","","LANTUS","INJ 100\/ML","","Select","Select",""],["","","HUMALOG","INJ 100\/ML","","Select","Select",""],["","","INSULIN","INJ 100\/ML","","Select","Select",""],["","","HM","PAD ALCHOL","","Select","Select",""],["","","FREESTYLE    MIS LITE","MIS LITE","","Select","Select",""],["","","BISCOLAX","SUP 10MG","","Select","Select",""],["","","BISACODYL","SUP 10MG","","Select","Select",""],["","","BD  PEN NEEDL","MIS 32GX4MM","","Select","Select",""],["","","DICYCLOMINE","CAP 10MG","","Select","Select",""],["","","BROM\/PSE\/DM","SYP 2\/30\/10","","Select","Select",""],["","","CVS","TAB 10MG","","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","69452014330","BENZONATATE","CAP 100MG","30","Select","Select",""],["","68382013805","TOPIRAMATE","TAB 25MG","60","Select","Select",""],["","61314062810","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""],["","62542030104","HYD","SUS 10-8\/5ML","60","Select","Select",""],["","00603107558","CHERATUSSIN","SYP AC","120","Select","Select",""],["","68462018022","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00591336901","BUT\/APAP\/CAF","TAB ","12","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}